Physicians Receiving Gifts from Pharmaceutical Industry More Likely to Prescribe Branded Drugs

Recent findings suggest that a majority of Americans receive care from physicians who received payments or gifts from pharmaceutical manufacturers or medical device companies. However, very few patients are aware of this, according to a study published by the Journal of General Internal Medicine.

Included in the study were data from 3500 adults and their physicians from Open Payments, which is a government-run website that reports payments to physicians.

The study authors indicated that 66% of individuals included in the analysis had visited a physician within the past year who received some form of payment from these companies, but only 5% of patients indicated that they knew the physician accepted the payment.

"These findings tell us that if you thought that your doctor was not receiving any money from industry, you're most likely mistaken," said researcher Genevieve Pham-Kanter, PhD. "Patients should be aware of the incentives that their physicians face that may lead them to not always act in their patients' best interest. And the more informed patients are about their providers and options for care, the better decisions they can make."

Open Payments was implemented as a part of the Sunshine Act, under the Affordable Care Act (ACA), to increase transparency and allow public access to the information. The investigators gathered data from September and October 2014 for Minnesota, Massachusetts, and Vermont where the information was available prior to public release, according to the study.

While a majority of patients visited physicians who received payments, the prevalence was even higher among patients seeing specialists. Approximately 85% of patients receiving care from an orthopedic surgeon saw a physician who had received payments, while 77% of patients visiting an obstetrician or gynecologist saw a physician who received payments, according to the study.

Other studies have found that physicians who accept payments and gifts are more likely to prescribe costlier branded drugs opposed to generics, which may call into question the ethics behind the payments.

"Drug companies have long known that even small gifts to physicians can be influential, and research validates the notion that they tend to induce feelings of reciprocity," said study co-author Michelle Mello, PhD.

While the amount gifted to physicians varied, the differences were not observed to be random, according to the study. The national average is $193 in payments and gifts, but payments over the past 12 months for those physicians visited by the study participants were $510.

"We may be lulled into thinking this isn't a big deal because the average payment amount across all doctors is low," Dr Pham-Kanter said. "But that obscures the fact that most people are seeing doctors who receive the largest payments."

Of all participants, only 12% knew they could access their physician’s payments through the government platform.

In 3 of the states where payment transparency information was available prior to the ACA, only 34% of patients saw physicians who received payments, compared with 66% of all patients. The study authors believe that physicians may be more likely to deny payments if the information is being accessed.

"Transparency can act as a deterrent for doctors to refrain from behaviors that reflect badly on them and are also not good for their patients," Dr Pham-Kanter said.

However, patient knowledge about Open Payments and physician payments in general is lacking.

"Some of it may be related to how easy or difficult it is to access this information," Dr Pham-Kanter said.

Due to the uncertainty of the future of the ACA and its provisions, Open Payments may be repealed in the future. As a result, the study authors are concerned over healthcare transparency moving forward.

"If the Sunshine Act, as part of the Affordable Care Act, is repealed, it will certainly move us backwards," Dr Pham-Kanter concluded. "There has been a lot of useful information -- for patients, policymakers and researchers -- that has come out about the scope and scale of these payments and how they might influence doctors, and I'm sure there's much more to learn."